The Life Scientific: Jonathan Shepherd

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0:30at Whole Foods Market. How did a boycott Jimmy become a billionaire from posting videos? On Good Bad Billionaire, we're going to find out how the world's most popular YouTuber, Mr Beast, made his fortune. He's buried himself in a coffin for days. Counted to 100 ,000 on camera. And even recreated Squid Games, all in an attempt to go viral on the internet. But it all started when he gave a homeless man$10 ,000. So is he a philanthropist reshaping capitalism? Or is he just the king of the attention economy? Find out on Good Bad Billionaire. Listen on BBC.com or wherever you get your podcasts. My guest today is a maxillofacial surgeon.

1:09That's relating to the face, mouth, neck and jaw with an unusual side hustle, fighting crime. That does make him sound a bit like a scientific superhero, which actually isn't far off the mark because Jonathan Shepard not only recognised the link between public violence and emergency hospital admissions, he did something about it. Jonathan is an emeritus professor of oral and maxillofacial surgery at Cardiff University, where he's also director of their Crime Security and Intelligence Innovation Institute. He devised the Cardiff Model for Violence Prevention, a programme where hospitals share data about admissions relating to violent attacks with local authorities.

1:50And beyond that, as head of the university's violence prevention group, Jonathan has studied various aspects of this behaviour to deliver evidence-based solutions, from alcohol restrictions in hotspots to less breakable beer glasses in pubs. The results have been significant, delivering reductions in hospital admissions and violent attacks recorded by police. And that's not limited to the Welsh capital. Today, the Cardiff model is used in cities across the UK and indeed the world. If achieving that doesn't count as a superpower, I don't know what does. Professor Jonathan Shepard, welcome to The Life Scientific.

2:25Thanks very much for inviting a clinical scientist. You're very welcome. Now, we're going to talk about all your research behind the Cardiff Model for Violence Prevention later on, but for now, can you just give me an overview of what it is and how it works? The Cardiff Model for Violence Prevention is the use of specific data from A &Es, combining that with police data and then the use of that data by a executive group of police local government health education executives so the the active ingredients over and above what we traditionally do is the use of a and e data to identify violence hot spots weapon use etc and secondly this executive group for violence prevention and for every city needs a violence Prevention Board.

3:16And I think most of us expect medics to be engaged with the injuries they treat, but I'd imagine far fewer get involved with the other side of that equation, the drivers behind the injury, because really that's a whole separate job. But you did. Yeah, I've always thought that we've got to have prevention as well as cure. It's made me realise that it's all very well treating patients, and that's hugely important, Of course it is. But raising the sights a bit and preventing violence to make the cities that I've worked in safer. So what was it that got you first thinking about the link between public violence and A &E admissions?

3:54It really happened when I was training to be an NHS consultant in Leeds. And at that time, there were strikes in the Yorkshire coalfield in the 1980s. and I remember one of the consultants I was working with said, oh, we always see more assault patients, he meant people injured in violence when there's a miners' strike. And at the same time, I noticed that we were getting a lot of people injured in violence from the same licensed premises. And what were the typical maxillofacial injuries you were seeing as a result of that violence? Oh, broken jaws, cut faces, broken eye sockets, broken noses, all sorts of permanently disfiguring injuries and costly injuries of course and time consuming and they pitch up oftentimes at the weekend when services are most expensive.

4:43And has the style and frequency of those incidents changed much during the time you've been studying them? Yes it has. The numbers of people coming to A &Es in England and Wales has decreased by 60%, 60 % since 2000. Crikey. And that comes from the annual report on violence in England and Wales based on A &E data. Goodness me, that's huge, 60%. It is. This feels like a tough area to work in, Jonathan, because we're talking about intentional conflict-based injury and immersing yourself in it means confronting both the hostility and the resulting trauma. That must take its toll. So how do you deal with it?

5:26The training helps a great deal and it's very important that we treat everybody objectively and compassionately. But it's very easy to just become immune to the human tragedy that is underneath all those injuries. And I think my Christian faith helps a great deal because it's been real throughout my career and it's been profound. And I think looking back, the sense of guidance has been clear. And it was something instilled in you from childhood. So maybe we can hear more about that. You were born in Plymouth in 1949. What did your parents do? My father was a dentist and he spent almost all his working life after leaving the Air Force in World War II in a small town in North Devon, Torrington.

6:19My mother was a land girl in the war and I have three brothers, so she looked after the family basically right from the time when she was 18. And as a child, you had a real fascination with all things practical. Yeah, I loved the practical work at school and connections between things were important. So I remember being very interested in maps and the railway system, bridges as well. I remember drawing bridges, trying to make up new designs for bridges. It sounds like a generally happy childhood, but I gather your teenage years were more difficult. Yeah, things were fine up until O-Level, that's GCSE times, and then in the sixth form I got depressed, and that was hard.

7:08A lonely kind of time in this small Devon town where not much to do, you know, with Dartmoor 20 miles away, depressingly in the distance. And it affected my A-level studies. And I had to repeat one of the A-levels as a result of that. I mean, nowadays, of course, mental health is much higher up the agenda. And we have a better understanding of depression and how it can be treated. But as a teenager in the 1960s, how did you deal with it? To be honest, I just I didn't really know what was happening to me um I thought everybody must probably feel the same way but clearly they didn't and a big switch I retook an A-level in four months and then I went to work for the Walls ice cream company in Gloucester making ice cream and that was a relief and a change but then the most important thing was starting life as a student because you did get your biology A-level in the end.

8:06When you went to King's College London, it's 1969, you started at their dental school and you really threw yourself into student life. I loved it. I worked harder than I'd ever worked before, but also played harder as well. A lot of sports, cross-country running, went to most of the London soccer grounds and the theatre and went to the proms. So it was a complete revolution from the kind of thing I was experiencing in this small Devon town. And in terms of your studies, you must have thought you'd be following your father's footsteps going into dentistry as a career. It was the last thing I wanted to do.

8:44Okay. I was actually loving the surgical aspects of dentistry. So you started a residency in the Department of Oral and Maxillofacial Surgery at King's College Hospital, and then Queen Victoria Hospital in East Grinstead. And that's where your fascination with the field, and importantly, research in this field, was actually born. Yes, it was a famous hospital, of course, which treated a lot of the burnt air crew in the Second World War. But there was a visiting professor there, David Poswillow, and on his operating list one day, and I was, of course, working up the list for him, he had a patient with the kind of cyst in the jaw that recurs it's not a malignant but it just recurs and so the boss decided to pour liquid nitrogen into the cavity to try and stop recurrence this is while we were actually operating and um i said well what happens to the teeth either side you know all the nitrogen fog everywhere around the patient and around us and within a week i was in the royal college of surgeons Research Institute at Down House, experimenting on rats actually freezing their maxillia and then seeing what happened to the teeth.

9:55And the specialist cells that make dentine were all killed off, but the teeth remained alive, vital. The blood supply wasn't lost. But that was the topic of my first research paper. Well, this work of yours on cryosurgery, low temperature interventions, continued at the University of Oxford, where you moved in 1975 for your master's. and I think it was around that time that you met your future wife Daphne. We met through a mutual friend actually on holiday in the south of France in a villa with an olive grove. It was very romantic. A few years later the two of you moved to Leeds where you continued your training to become a consultant and shortly after moving you and Daphne got married.

10:35But you didn't have long to settle into local life there because an interesting overseas opportunity cropped up. There was a vacancy on a rotation for surgeons near the end of their training in Nigeria. So I was seconded by the Foreign and Commonwealth Office, actually the Overseas Development Administration then, to work in the Armadu Bello University Hospital in Kaduna in North Nigeria. And that was a hugely important time for me. lots of surgery. I did more cleft lip and palate procedures than I'd ever expect to do in the UK and lots of other things as well, including removing huge tumours from the faces and jaws of people there.

11:20And you came back to Leeds the following year, but almost immediately fell ill yourself. And operated on a lot of patients. And as a result of that, I contracted hepatitis B, which back then was quite unusual and people weren't routinely vaccinated and so six weeks after I got home to Leeds I looked in the mirror one morning and I thought I'm jaundiced so that was the start of two and a half months off. Well Jonathan Shepard a few years later you moved south to take up the role of senior lecturer in oral and maxillofacial surgery at the University of Bristol where you also began a PhD and become fascinated by the connection between violence and injuries How did you investigate that further then?

12:04Well, I decided to study 539 consecutive patients injured in violence who came to the A &E in the Bristol Royal Infirmary and look at the social circumstances, their alcohol use and with control individuals who'd been injured similarly in accidents and then the weapons that they were injured with, the psychological impact and I was actually short of a chapter I thought this is looking a bit thin so I thought well let's compare data from A &E with data from the police and was what shocked it's not an understatement to find that the police only knew about a quarter of the violence that put people in hospital and I thought this is extraordinary because that means that the main agency to do with tackling violent crime is blind to three quarters of the patients that come in injured into hospital.

13:04That is surprising. When someone's injured and they're taken to A &E to hospital, there's no then or wasn't any follow-up to inform the police of the crime that had taken place. Yeah, and we then got an Economic and Social Research Council grant to explore why this was. And basically, we discovered that the reason the police don't know is that reporting violence depends very much on the injured people telling the police. But many don't. Right. Well, all of this, Jonathan Shepard, was the groundwork for what would eventually become the Cardiff model for violence prevention. So-called because in 1991, you moved across the Severn Estuary to join the University of Wales College of Medicine, which later merged with Cardiff University.

13:49You joined as head of oral surgery, medicine and pathology, and you had big ideas about wanting to devise a public health approach to policing. Well, violence at that time was seen almost exclusively as a criminal justice issue. And I thought, you know, there is myself and 250 consultant surgeons up and down the country whose work is dominated by people injured in violence. So it's clearly a health issue. So, yeah, we wrote an article with David Farrington, who's a criminologist, unfortunately just passed away at Cambridge University, proposing that violence should be seen as a public health issue.

14:47Corticinal cheese. Then fire up the grill with no antibiotics ever. Proteins and fresh produce. Savour the season. Shop Summer Fruit Fest at Whole Foods Market. How did a boy called Jimmy become a billionaire from posting videos? On Good Bad Billionaire, we're going to find out how the world's most popular YouTuber, Mr Beast, made his fortune. He's buried himself in a coffin for days. Counted to 100 ,000 on camera. And even recreated Squid Games, all in an attempt to go viral on the internet. But it all started when he gave a homeless man$10 ,000. So is he a philanthropist reshaping capitalism?

15:21Or is he just the king of the attention economy? Find out on Good Bad Billionaire. Listen on BBC.com or wherever you get your podcasts. In the summer of 1997, you held the first meeting of what would become Cardiff's Violence Prevention Board. How did that meeting go? Innovating. It's a bit like blowing up a balloon. You know, the first puff is the most difficult. And I thought, well, if a lot of violence is not known to the police and is known to A &E, then we need to call a meeting. And so I convened a meeting of police, local government and health people together with victim support. And it started really small scale, you know, meetings in the back of council chambers, you know, and odd times at the end of the day.

16:09But it became the prototype violence prevention board, which is widely replicated now. And we agreed to try to see if we could prevent violence in the city of Cardiff more effectively using A &E data and a joint effort. So you developed the Cardiff model and it's now used across the UK and in various other countries. How does it feel to reflect on that? Yeah, it's rewarding. And the evaluations show that it works. There's been reviews of evidence done by public health academics in the University of Cape Town and in Deakin University in Australia. And they both show a clear benefit in tackling violence in this way.

16:52So from a scientific point of view, it's encouraging. In 2019, the Home Office here in the UK did an impact assessment signed off by the Home Secretary, Sajid Javid at the time, and basically concluded that if the Cardiff model was implemented in just 5 % of local authority areas, the cost saving over 10 years would be£858 million. And, of course, violence costs in terms of A &E treatment. It costs in terms of probation, prisons, police, the justice system. So there are savings right across those sectors when violence is reduced. Well, a few years later, Jonathan, you were able to put some of your research to practical use with a major campaign to reform the pub trade.

17:42One of the findings in my PhD was that 10 % of people injured in violence had been injured with glass weapons. So as a follow up, we did a survey and found that it was the straight sided glasses with the bulge near the top standard lager glasses, which were the most commonly used weapon. we then did a lab study to look at the impact resistance of all the glasses of that type then available and the discovery there was that toughened glass as in windscreens increased resistance to breakage so we did a randomized trial of toughened pint glasses in 54 pubs in west midlands and south Wales and that showed that there was a 60 % benefit in terms of breakage and injury and I thought well it's not good enough just to do that and report it in the literature we need a campaign to switch to toughen glass and so got together with the old Welsh Development Agency and put together what we called the face of Wales campaign to advocate a switch to toughen glass in the pub trade and after Quite a lot of hard work and advocacy and some resistance from the manufacturers.

18:56The whole pub trade switched over in the late 1990s to toughen glass. I imagine that has particular resonance for you, given you've been an expert witness in some high-profile trials relating to glass attacks. Yeah, that was the background for being an expert witness in cases including the murder of Damilola Taylor in South London and Jimmy Mizzen in a bakery also in London. So, yeah, those were high-profile cases. And it's important to communicate just as well as you possibly can and try and simplify things, and it's about being clear. We should talk about some of your other research, Jonathan, because you've made waves in fields other than violence prevention.

19:39In the 80s and early 90s, you did a lot of work on wisdom teeth, specifically looking at the surgical removal of molars. How common was that at the time? The surgical removal of wisdom teeth back in the early 1980s was one of the four most commonly carried out surgical procedures in the NHS and also very commonly up there in the top two or three in the private sector as well. and that had come about really because of the use of panoramic x-rays where wisdom teeth were just found and if they were tilted or not quite the right they were scheduled for removal and I thought there's got to be more rationale for this so we looked at decision making we looked at anaesthetic choice we looked at what patients thought about the complications of either leaving them there or not and the conclusion was that the prophylactic removal of wisdom teeth In other words, removal where there's no disease was the wrong thing to do.

20:39So our editorial saying that was published in the British Medical Journal in 1993. That was a high impact paper in a top international journal. But I gather some of your peers weren't very happy. Yeah, I remember. I shouldn't have been surprised. I think sometimes innovators need a little naivety. But the president of the British Association of Oral and Maxillofacial Surgeons wrote to me and said at a page and a half that I'd betrayed the specialty. And that was difficult. It was because a lot of my obviously my friends and colleagues were in that association. So I did feel ostracized for a few years.

21:23But this wasn't because of the science. This is because you were removing, I guess, crudely a nice little learner. Yeah, I think it's true that private practice would be threatened by a conclusion like that. The private patients plan insurer were very pleased with this, of course, because it meant less money going out for them. But it was clearly the right thing to do. There was almost indiscriminate removal of wisdom teeth back then. But then to the credit of the profession, practice changed and the numbers of those operations decreased substantially. before the first NICE guidance was published in 2000, which said exactly the same thing.

22:06So you were proven right ultimately. And in fact, over the years, you haven't been put off using your research to reform. In the late 90s, you started looking into cycle helmets. One of our trainees, he was looking for a research project. And we thought, well, let's have a look at cycle helmets and the facial protection that they give. So we got hold of a hairdresser's mannequin and then we rigged up lighting and used a shadow that each of the helmets that we put on the mannequin as a measure of the facial protection that the helmet provided. And it was clear from that that the facial protection was pretty minimal, actually, from the psychoelmet design.

22:49And at the same time, we did a clinical study in three A &Es in South Wales, looking at the patterns of injury in cyclists who'd been injured. And that showed that there was a lot of lower face injury that we thought could be prevented. So we wrote two research articles which were published. And without any advocacy on our part, a Formula One engineer working for McLaren rang us up and said, I think I could make a prototype of a cycle helmet with lower face protection. And then he persuaded the Formula One, the McLaren driver, David Coulthard, to put up the venture capital for the production of what was then marketed as the face saver helmet.

23:33And the long-term effect of that was that cycle helmets, especially for the cycle sports, still now routinely have face protection incorporated into the helmets. That's quite remarkable. It's interesting, Jonathan, that your research frequently goes beyond treatment to prevention, finding the data to inform practical change. And that idea of evidence informing best practice is clearly important to you. In fact, you were instrumental in setting up three new professional bodies to help with that aspect. So what were they? The College of Policing, the professional body for policing, the probation institute because probation officers didn't have a professional body and then I was asked by the education select committee in the house of commons to speak to teachers leaders about the benefits of a professional body for teachers and then served on the commission which wrote the blueprint for what is now the chartered college of teaching but all this came actually from chairing Cardiff's violence prevention board and noticing the huge huge contrast there were between the backgrounds of the professions represented around the table.

24:44So just in relation to policing, they didn't have a professional body. There was no what work centre like NICE to publish guidance on how they should operate. There was no research funding body like the Medical Research Council or the National Institute for Health Research. And so I wrote an article for a journal advocating bodies which produce authoritative guidance based on the evidence in all these other sectors. And this is, of course, what led eventually to the creation of the What Works Network, which you established with the Cabinet Office in 2013. Yes, basically, this idea of having what works centres, call them that, nice equivalents in the other sectors.

25:26So we now have authoritative guidance in crime reduction, education, health, local economic growth and this is a way of ensuring that the interventions really are evidence-based. In 2018 Jonathan you became an Emeritus Professor at Cardiff University and remained a co-director of their Crime Security and Intelligence Innovation Institute. What's your research they're focusing on right now? Well in my own work we publish an annual report on violence in England and Wales based on data from over 100 A &Es. The 25th one will be published in April, so that's going to be a milestone. And then just one other example, we studied links between alcohol prices and the risk of injury and violence and found there was a direct link.

26:18And then we also found that when the duty on alcohol was increased routinely year on year at the time of the budget, there was a dip in violence every April. But this is before George Osborne, when he was chancellor, scrapped what's known as the duty escalator in 2014. So that helped persuade the current government to increase duty in line with inflation on some alcoholic drinks. And that's happened very recently. There's more to do. If that became routine, that would be a slow but sure way of decreasing the risk of injury in violence. right at the start of our conversation i called you a scientific superhero so considering your own arguably rather unconventional career do you think more scientists should follow your lead i found that as a practitioner myself innovation and practical research in services is much more straightforward than it would have been if i was non-clinical if I wasn't a practitioner.

27:26Of course, professors of orthopaedics or professors of general practice or maxillofacial surgery, they're all doing six sessions a week of practice and four sessions a week doing research, you know, innovating. And I think that that is a fantastically helpful model. It's brought so much innovation and progress. And so my dream is that we'll have professors in policing, say at assistant chief constable level, who will have chairs in local universities. So six sessions a week, they'll be doing practical policing, managing police force. But the other four sessions, they'll be doing research on policing and publishing their work and innovating.

28:06Same in schools. It's very uncommon for a teacher to also be an academic. So having a professor of education who sits in a school, have their office in a school rather than a campus away from the coalface of education, I think that would be great benefit in moving that model forward. Jonathan Shepard, thank you very much for sharing your life scientific. Thank you. And thank you for listening. I'm Jamal Kalili and my producer is Lucy Taylor. How did a boycott Jimmy become a billionaire from posting videos? On Good Bad Billionaire, we're going to find out how the world's most popular YouTuber, Mr Beast, made his fortune.

28:47He's buried himself in a coffin for days. Counted to 100 ,000 on camera. And even recreated Squid Games, all in an attempt to go viral on the internet. But it all started when he gave a homeless man$10 ,000. So is he a philanthropist reshaping capitalism? Or is he just the king of the attention economy? Find out on Good Bad Billionaire. Listen on BBC.com or wherever you get your podcasts.